weight

• Kava can cause severe liver injury
• Ma huang (ephedra) contains ephedrine, which can elevate blood pressure and stimulate the heart and CNS
• Obesity may be associated with hypertension, coronary heart disease, stroke, type 2 diabetes, gallbladder disease, kidney stones, osteoarthritis, sleep apnea, dementia, and certain cancers
• Health risk factors

  • Degree of obesity
  • Pattern of fat distribution
  • Presence of obesity-related diseases or cardiovascular risk factors
• The body mass index (BMI) is a simple way to estimate body fat content
• People with too much abdominal fat are at increased risk for insulin resistance, DM, hypertension, coronary atherosclerosis, ischemic stroke, and dementia
• A waist circumference exceeding 40 in (102 cm) in men or 35 in (88 cm) in women signifies an increased health risk
• Health risk rises as BMI gets larger
• Several genes contributing to weight gain have been identified
• The FTO gene is thought to cause up to 15% to 20% of obesity cases
• FTO gene variants can disrupt systems leading to increased fat storage
• Dysregulation of hormones that stimulate and suppress appetite can promote weight gain
• Weight gain have been identified
• FTO gene

  Fat- and obesity-associated gene
• Fat cell alteration

  Results in increased fat storage relative to expenditure
• Hypothalamus

  Contains neurons that produce neuropeptides that orchestrate nutrient utilization and storage
• A decrease in hypothalamic neurons or in their neuropeptide production can result in weight gain even when intake is reasonable
• Ghrelin


  An appetite stimulant produced predominantly in the stomach
• Leptin


  An appetite suppressant produced by fat cells
• Ghrelin levels typically decrease after eating and create hunger as they rise again before mealtime or after a period of fasting
• Leptin is involved in the ongoing control of intake
• Many overweight people develop leptin resistance
• As a result of leptin resistance, these people do not experience satiety despite their high levels of leptin
• The same factors that promote weight gain

  Remain in effect following weight loss
• As people lose weight, leptin levels drop; therefore satiety is lessened
• Ghrelin levels rise after dieting, thus stimulating hunger
• Algorithm for treating obesity

  1. Stage 0: BMI 25+ no complications: Lifestyle therapy; drug therapy if ineffective

  2. Stage 1: BMI 25+ with mild to moderate complications: Lifestyle therapy; drug therapy if ineffective or BMI 27+

  3. Stage 2: BMI 25+ with significant complications: Lifestyle therapy; drug therapy for BMI 25-26; initiate drug therapy for BMI 27+; consider bariatric surgery for BMI 35+
• A weight loss of 10% to 15% is typical for those who diligently adhere to medication and lifestyle therapy
• A loss greater than 15% is exceptional
• If weight loss plateaus, patients should be evaluated for improvement of weight-associated complications
• If complications have not improved, weight-loss efforts should be intensified
• If weight loss goals are achieved, it is important to set a goal to prevent lost weight from returning
• A reduced-calorie diet is central to any weight-loss program
• Physical activity should be a component of all weight-loss and weight-maintenance programs
• According to the American College of Sports Medicine, people trying to lose weight should exercise at least 150 minutes per week
• Those trying to maintain weight loss should exercise 200 to 300 minutes per week
• Behavioral therapy

  Directed at modifying eating and exercise habits
• Research demonstrates that the addition of weight loss drugs to obesity management promotes greater success than lifestyle management alone
• Weight loss attributable to drugs generally ranges between 4.4 and 22 lb
• Most weight loss occurs during the first 6 months of treatment